The results of a double-blind trial of pulsed electromagnetic frequency in the treatment of Perthes' disease.

A double-blind trial of the use of pulsed electro-magnetic frequency (PEMF) in the treatment of Perthes' disease was constructed by using this therapy to supplement a long-practised non-weight-bearing orthotic treatment, the Birmingham Containment Splint. Twenty-one boys with Perthes' disease were treated with this combined regimen; they were divided into two groups. All wore the orthosis but the treatment coil was inactive in one group; the state of coil activity was unknown to clinic staff or patients. The duration of non-weight-bearing orthotic treatment needed to achieve a stated degree of femoral head reconstitution was recorded; there was no discernible difference between the two groups, treatment time being 12 months in one group and 12.5 months in the other. It was concluded that PEMF cannot be offered for the therapy of Perthes' disease.

Beneficial effects of electromagnetic fields.

Selective control of cell function by applying specifically configured, weak, time-varying magnetic fields has added a new, exciting dimension to biology and medicine. Field parameters for therapeutic, pulsed electromagnetic field (PEMFs) were designed to induce voltages similar to those produced, normally, during dynamic mechanical deformation of connective tissues. As a result, a wide variety of challenging musculoskeletal disorders have been treated successfully over the past two decades. More than a quarter million patients with chronically ununited fractures have benefitted, worldwide, from this surgically non-invasive method, without risk, discomfort, or the high costs of operative repair. Many of the athermal bioresponses, at the cellular and subcellular levels, have been identified and found appropriate to correct or modify the pathologic processes for which PEMFs have been used. Not only is efficacy supported by these basic studies but by a number of double-blind trials. As understanding of mechanisms expands, specific requirements for field energetics are being defined and the range of treatable ills broadened. These include nerve regeneration, wound healing, graft behavior, diabetes, and myocardial and cerebral ischemia (heart attack and stroke), among other conditions. Preliminary data even suggest possible benefits in controlling malignancy.

Long-term pulsed electromagnetic field (PEMF) results in congenital pseudarthrosis.

Ninety-one patients with congenital pseudarthrosis of the tibia have been treated with pulsed electromagnetic fields (PEMFs) since 1973 and all except 4 followed to puberty. Lesions were stratified by roentgenographic appearance. Type I and type II had gaps less than 5 mm in width. Type III were atrophic, spindled, and had gaps in excess of 5 mm. Overall success in type I and II lesions was 43 of 60 (72%). Of those 28 patients seen before operative repair had been attempted, 7 of 8 type I lesions healed (88%), whereas 16 of 20 type II lesions healed (80%) on PEMFs and immobilization alone. Only 19% (6 of 31) type III lesions united, only one of which did not require surgery. Sixteen of 91 limbs (18%) were ultimately amputed, most before treatment principles were fully defined in 1980. Fourteen of these 16 patients (88%) had type III lesions. Refracture occurred in 22 patients, most as the result of significant trauma, in the absence of external brace support. Twelve of the 19 refractures, retreated with PEMFs and casts, healed on this regime. Episodic use of PEMFs proved effective in controlling stress fractures in several patients until they reached puberty. PEMFs, which are associated with no known risk, appear to be an effective, conservative adjunct in the management of this therapeutically challenging, congenital lesions.

Healing of nonunion of a fractured lateral condyle of the humerus by pulsing electromagnetic induction.

Nonoperative salvage of a surgically resistant case of established nonunion of a fracture of the lateral condyle of the humerus in a child is described. Solid union was achieved by treatment with pulsed electromagnetic fields. A review of the literature indicates that this is the first published report of such a case.

Bone density changes in osteoporosis-prone women exposed to pulsed electromagnetic fields (PEMFs).

To determine the effect of a 72 Hz pulsating electromagnetic field (PEMF) on bone density of the radii of osteoporosis-prone women, the nondominant forearms of 20 subjects were exposed to PEMF 10 h daily for a period of 12 weeks. Bone density before, during, and after the exposure period was determined by use of a Norland-Cameron bone mineral analyzer. Bone mineral densities of the treated radii measured by single-photon densitometry increased significantly in the immediate area of the field during the exposure period and decreased during the following 36 weeks. A similar but weaker response occurred in the opposite arm, suggesting a "cross-talk" effect on the nontreated radii, from either possible arm proximity during sleep or very weak general field effects. The data suggest that properly applied PEMFs, if scaled for whole-body use, may have clinical application in the prevention and treatment of osteoporosis.

Effects of pulsed electromagnetic fields on Steinberg ratings of femoral head osteonecrosis.

Between 1979 and 1985, 95 patients with femoral head osteonecrosis met the protocol for treatment of 118 hips with selected pulsed electromagnetic fields (PEMFs). Etiologies included trauma (17), alcohol (9), steroid use (46), sickle cell disease (2), and idiopathy (44). The average age was 38 years, and the average follow-up period since the onset of symptoms was 5.3 years. PEMF treatment had been instituted an average of 4.1 years earlier. By the Steinberg quantitative staging method of roentgenographic analysis, none of the 15 hips in Stages 0-III showed progression, and grading improved in nine of 15. Eighteen of 79 hips (23%) with Stage IV lesions progressed and none improved. In the Stage V category, one of 21 hips (5%) worsened and none improved. Three Stage VI lesions were unchanged. The overall rate of quantified progression for the 118 hips, 87% of which had collapse present when entering the program, was 16%. This value represents a reversal of the percentage of progression reported recently by other investigators using conservative and selected surgical methods. PEMF patients also have experienced long-term improvements in symptoms and signs, together with a reduction in the need for early joint arthroplasty.

Fundamental and practical aspects of therapeutic uses of pulsed electromagnetic fields (PEMFs).

The beneficial therapeutic effects of selected low-energy, time-varying magnetic fields, called PEMFs, have been documented with increasing frequency since 1973. Initially, this form of athermal energy was used mainly as a salvage for patients with long-standing juvenile and adult nonunions. Many of these individuals were candidates for amputation. Their clearly documented resistance to the usual forms of surgical treatment, including bone grafting, served as a reasonable control in judging the efficacy of this new therapeutic method, particularly when PEMFs were the sole change in patient management. More recently, the biological effectiveness of this approach in augmenting bone healing has been confirmed by several highly significant double-blind and controlled prospective studies in less challenging clinical circumstances. Furthermore, double-blind evidence of therapeutic effects in other clinical disorders has emerged. These data, coupled with well-controlled laboratory findings on pertinent mechanisms of action, have begun to place PEMFs on a therapeutic par with surgically invasive methods but at considerably less risk and cost. As a result of these clinical observations and concerns about electromagnetic "pollution", interactions of nonionizing electromagnetic fields with biological processes have been the subject of increasing investigational activity. Over the past decade, the number of publications on these topics has risen exponentially. They now include textbooks, speciality journals, regular reviews by government agencies, in addition to individual articles, appearing in the wide spectrum of peer-reviewed, scientific sources. In a recent editorial in Current Contents, the editor reviews the frontiers of biomedical engineering focusing on Science Citation Index methods for identifying core research endeavors. Dr. Garfield chose PEMFs from among other biomedical engineering efforts as an example of a rapidly emerging discipline. Three new societies in the bioelectromagnetics, bioelectrochemistry, and bioelectrical growth and repair have been organized during this time, along with a number of national and international committees and conferences. These activities augment a continuing interest by the IEEE in the U.S. and the IEE in the U.K. This review focuses on the principles and practice behind the therapeutic use of "PEMFs". This term is restricted to time-varying magnetic field characteristics that induce voltage waveform patterns in bone similar to those resulting from mechanical deformation. These asymmetric, broad-band pulses affect a number of biologic processes athermally. Many of these processes appear to have the ability to modify selected pathologic states in the musculoskeletal and other systems.(ABSTRACT TRUNCATED AT 400 WORDS)

Results of conservative management of osteonecrosis of the femoral head. A retrospective review.

This retrospective review of 50 osteonecrotic femoral heads in 36 young patients demonstrates the general futility of conservative treatment in slowing progression to total hip arthroplasty (THA). Etiologic factors, i.e., alcoholism, steroids, and idiopathic, did not appear to modify the rate or pattern of clinical deterioration. Pathogenetic stages, i.e., Ficat II to IV, seemed unrelated to the degree of disability. Despite modified weight-bearing, analgesics, and antiinflammatory agents, only three of 50 hips (6%) remained clinically stable and none improved. Thirty-four of the 50 osteonecrotic hips (68%) had been treated by THA after a mean interval of 16 months. In an additional four hips (8%) THA had been recommended, but not carried out. Progressive femoral head collapse was documented in 67% of the hips, the remainder, having reached an end stage (Ficat IV). This study confirms previous reports of the inability of bed rest, crutches, or other ambulatory aids to arrest the progression of femoral head collapse and increasing disability in young individuals with osteonecrosis of the hip.

Effect of external pulsing electromagnetic fields on the healing of soft tissue.

Since fibroblast behavior in bone healing can be altered electrically, it is plausible to hypothesize that fibroblast proliferation and function in soft tissue healing also would respond to an electromagnetically induced pulse. Reports of clinical impressions of accelerated closure of chronic skin wounds overlying areas being treated for nonunion have produced support for this hypothesis, but experimental data have been lacking. This study was designed to evaluate the effect of pulsed electromagnetic fields (PEMFs) with clinically employed wave-form parameters on the rate of closure of excisional wounds in normal animals and those with steroid retarded wound healing. Four groups, each containing 12 PEMF-treated rats and 12 control rats, were given different field exposures and two groups were treated with methylprednisolone. The wound areas were measured and tissue was harvested for histological examination at intervals for 28 days after wounding. There was no difference in the gross or microscopical appearance of wounds in each active group and its respective control group. Differences in the number of counted fibroblasts were not significant (p less than 0.5), and wound contraction and epithelialization proceeded at the same rate (t-test for equality of means, power = 90%). Electrical PEMF stimulation with the driving pulse used clinically for nonunion bony repair did not affect soft tissue healing in this model. No experimental support is provided for the reports of accelerated skin healing within therapeutic fields. It is possible that different wave-form characteristics are needed to provoke a response in soft tissue.

The development and application of pulsed electromagnetic fields (PEMFs) for ununited fractures and arthrodeses.

This article deals with the rational and practical use of surgically noninvasive pulsed electromagnetic fields (PEMFs) in treating ununited fractures, failed arthrodeses, and congenital pseudarthroses (infantile nonunions). The method is highly effective (more than 90 per cent success) in adult patients when used in conjunction with good management techniques that are founded on biomechanical principles. When union fails to occur with PEMFs alone after approximately four months, their proper use in conjunction with fresh bone grafts insures a maximum failure rate of 1 to 1.5 per cent. Union occurs because the weak electric currents induced in tissues by the time-varying fields effect calcification of the fibrocartilage in the fracture gap, thereby setting the stage for the final phases of fracture healing by endochondral ossification. The efficacy, safety, and simplicity of the method has prompted its use by the majority of orthopedic surgeons in this country. In patients with delayed union three to four months postfracture, PEMFs appear to be more successful and healing, generally, is more rapid than in patients managed by other conservative methods. For more challenging problems such as actively infected nonunions, multiple surgical failures, long-standing (for example, more than two years postfracture) atrophic lesions, failed knee arthrodeses after removal of infected prostheses, and congenital pseudarthroses, success can be expected in a large majority of patients in whom PEMFs are used. Finally, as laboratory studies have expanded knowledge of the mechanisms of PEMF action, it is clear that different pulses affect different biologic processes in different ways. Selection of the proper pulse for a given pathologic entity has begun to be governed by rational processes similar, in certain respects, to those applied to pharmacologic agents.